Category Archives: CBT

Post navigation

Her name is Megan, and she is the most beautiful soul. She was a senior in high school, and I was calling her with a question about her application to my university. As we talked– quite vulnerably for two people in their first conversation– I felt like I was talking to my senior-year self.

I heard OCD in her words and between her words.

I said, “Megan, can I tell you a little about me?” and I shared about my own experiences with OCD. I remember her voice saying, “That … sounds like me.”

At the end of the conversation, I said, “Now, the second we hang up, you are probably going to second-guess everything you said and worry that you misled me. Don’t. You didn’t.”

She said, in a voice of awe– the kind you get when you know someone really sees you– “I was already starting to go there. You really do get it!”

“I really do!” I said.

We had such a great talk that night, the first of many great talks. Megan now goes the university where I work, and it’s my joy to watch her thrive in her majors and on the theatre stage, to see her with her friends, see her growth as the most lovely young lady.

Everything about Megan is delightful. And it is tremendously meaningful for me to have the conversations with her that I so desperately needed someone to have with me as a college student. Psychoanalyze that all you want. 🙂 My past self is healing through my friendship with this girl. I really adore her.

All that to say, she wrote this poem, and I wanted to share it with you!

It’s called OCD, an enemy,With a gamut of tricks leading to slavery.I just want someone to rescue me.But there’s the catch,Before I’m free I just have to fetch,Or tell my mom, or say sorry to them,Then I can kiss OCD goodbye again.So I feel good and life is nice,Until I trip, meet another vice,Do another wrong or think something appalling,OCD grabs tight to make me start stalling.Cause the longer I wait, the more I engage,The tighter he grips, the fiercer his rage.Life in a corner is life in a cage,Give in to OCD, live on his stage,His wage, that never paysBut makes promises every day.No one gets it, it’s all inside,But it spills out ’cause he hates to hide.But he loves the shadows where no one understands,Where a girl is fighting him with trembling hands.No part of life is completely free,When controlled by OCD.It’s not the funny quirk you think,It’s not how many times you wash in the sink.It’s deep and real and crafty and meanIt makes reality not what it seems.It twists, distorts and sucks all life,To present as an OCD sacrifice.Never satiated, never appeased,Never leaving a victim in peace.

Until,she stops fighting, stops listening,Never meets the eyes wickedly glistening,Refuses to obey, stops cowering to his will,Though at first it hurts, she works still.And every fight she doesn’t pick,With the enemy and his crafty tricks,The weaker he grows, the less he attacks,The more his shadow retreats back.

For those who are longing to be free,Don’t play the game with OCD.He wants you blinded never to see,He wants nothing good for you or me.Don’t play his game, don’t answer his jokes,And soon his wagon will lose its spokes.And you’ll be free from OCD.No longer under bondage in slavery.

I think I have HOCD but I’m not sure. My therapist is doing CBT but I don’t think it’s ERP and it’s making me anxious. Like what if this therapy goes know where and just becomes me talking about my problems.(what happened with my last therapist). Should I trust that she knows what she is doing? Her Website says she does CBT so by saying she does CBT does that mean she is also an expert on ERP?

It’s sad, but so many mental health professionals are not very educated on OCD or how to treat it. CBT (cognitive-behavioral therapy) is a pretty vague, blanket term, whereas ERP (exposure and response prevention) is a specific type of CBT.

Two things I’d suggest:

Read up about ERP. As much as you can. It will help you recognize if it is being done correctly. Start with this article on the IOCDF website. Also read any/all of the CBT/ERP posts at www.jackieleasommers.com/OCD.

Ask your therapist the following questions. These questions– and the answers you should listen for— are pulled from this page on the IOCDF website.

“What techniques do you use to treat OCD?”If the therapist is vague or does not mention cognitive behavior therapy (CBT) or Exposure and Response Prevention (ERP) use caution.

“Do you use Exposure and Response Prevention to treat OCD?”
Be cautious of therapists who say they use CBT but won’t be more specific.

“What is your training and background in treating OCD?”If they say they went to a CBT psychology graduate program or did a post-doctoral fellowship in CBT, it is a good sign. Another positive is if a therapist says they are a member of the International OCD Foundation (IOCDF) or the Association of Behavioral and Cognitive Therapists (ABCT). Also look for therapists who say they have attended specialized workshops or trainings offered by the IOCDF like the Behavior Therapy Training Institute (BTTI) or Annual OCD Conference.

“How much of your practice currently involves anxiety disorders?”A good answer would be over 25%.

“Do you feel that you have been effective in your treatment of OCD?”This should be an unqualified “Yes.”

“What is your attitude towards medication in the treatment of OCD?”If they are negative about medication this is a bad sign. While not for everyone, medication can be a very effective treatment for OCD.

“Are you willing to leave your office if needed to do behavior therapy?”It is sometimes necessary to go out of the office to do effective ERP.

Meet Erin Venker. I know her through the leadership team for OCD Twin Cities. Erin is lovely, thoughtful, and smart– and she has a unique experience of having OCD and being an ERP therapist. I’m so pleased to be interviewing her on my blog today!

Tell us a little about your background in regard to OCD, Erin.

I first had symptoms in 5th grade but I wasn’t officially diagnosed until 7th grade. At that time, my OCD was mostly rituals of “breathing in” and “swallowing on” the letter A so I would get A’s in my classes. I also did a lot of magical thinking, for example, having lucky and unlucky colors. It soon evolved to include repetitive praying and confessing to mom thoughts, worries, and “bad” things I did, or else I believed something bad would happen. I frequently had horrible intrusive thoughts, both sexual and violent. That period of my life is fuzzy; I just remember it was extremely painful. Daily life was exhausting. I thought I was a horrible person and in constant fear that something bad was going to happen to my family. I was too embarrassed to talk about my intrusive thoughts, so I didn’t realize that was a part of my OCD until years later.

In college and post-college, my OCD evolved into primarily mental symptoms with rumination, trying to“figuring things out” by replaying scenarios over and over in my head, a constant fear of offending people, and reassurance seeking.

What led you to become a therapist? What are your educational credentials?

I didn’t receive the proper treatment for OCD until 14 years after I was diagnosed. It was at the OCD conference in Boston where I learned that exposure and response prevention therapy was the evidence based approach to successfully treat OCD. I also learned there how common taboo intrusive thoughts were, and that was a huge relief. I decided to become a therapist to help raise OCD awareness and expand the availability of treatment.

I received my master’s in counseling psychology at the University of Saint Thomas and have attended several workshops on exposure therapy. I currently work under the supervision of Dr. Vernon Devine who has 46 years experience treating individuals with anxiety disorders while I work toward my license as a professional clinical counselor.

Due to the rising costs of health care, insurance benefits have increasingly become more complex. Self pay ensures that the client’s records and diagnoses are entirely confidential documents as I will not have to submit them to insurance or a third party payer. The content of the sessions stays between myself, the client, and Dr. Devine.

Treatment often involves appointments that need to be longer than an hour, multiple sessions a week, at-home sessions, and public exposures. Self pay allows for treatment freedom as well as the time to get to the root of the problems the client is facing. It makes treatment much more effective. Typically treatment lasts no longer than three months before going to an as-needed appointment basis.

What are the benefits of exposure therapy? How does it work?

Exposure therapy works by essentially helping you confront what you fear the most. For example with contamination OCD, I’ll have clients work on touching and interacting with whatever they believe to be contaminated. If a client has a mental obsession fearing that they are attracted to a family member, we will make a script that they are in fact attracted to that family member. Basically whatever they avoid to protect themselves from their fears, we work up to doing that by creating a hierarchy. We start with whatever trigger the client finds the least distressing and expose them to that trigger until their anxiety decreases. We then gradually move up the hierarchy until the client is ready to confront the most difficult exposures.

Can you briefly describe how you guide a patient through ERP, especially what the first couple sessions might look like?

In the first session, I get to know the client, gather some background information, and go over an assessment I have them fill out before the appointment. We go over details about their presenting symptoms and explore their triggers. We then begin to build a hierarchy of ways to expose the client to the thoughts, images, objects, and situations that they find distressing and provoke obsessions/compulsions. ERP is no walk in the park, but it is an evidence-based approach that has shown to be incredibly effective.

Many of my blog readers are very concerned about being judged by a therapist who doesn’t truly understand OCD. What advice would you give to them?

Know that whatever intrusive thoughts or rituals you have, no matter how embarrassing, weird, or perverted you believe they are, I guarantee they are extremely common in OCD, and thousands of individuals have similar if not the same thoughts and compulsions. Everyone has intrusive thoughts– people with OCD just get them stuck in their head and distressed. Whatever you find most upsetting, OCD will latch onto it and continuously project it in your head like a song stuck on repeat.

Find a therapist who truly understands OCD. It breaks my heart when I hear about individuals who saw a therapist, tell them about sexual or violent intrusive thoughts they are experiencing, and the therapist does not recognize these symptoms as OCD. This can create further isolation, shame, and hinder the therapeutic process.

One last question: reassurance is often a compulsion for OCD sufferers. How can a therapist practice compassion without reassurance? What is your approach to this?

I use a lot of humor in treatment. I try to help clients notice when there OCD is sneaking up on them. Depending on the context and the individual, I will push the exact opposite of the reassurance they are seeking.

I have a rule of thumb that in the appropriate moment, I will only reassure once. I know you are not a pedophile, this is the one and only time I reassure you. After that, it’s all about accepting uncertainty. Well, maybe that thought does mean you want to kill someone, let’s make a script of it happening. At the same time, I validate the client that ERP is extremely difficult, and what they are doing is brave and hard work.

Thank you so much to Erin Venker for a great interview! If you are in the Twin Cities and think you could benefit from working with Erin, click here for her contact information.

If you’ve spent time around this blog, you know that I wrestled my life and freedom back from the clutches of obsessive-compulsive disorder in 2008. (Read more about my story at jackieleasommers.com/OCD).

From the onset of my symptoms to my diagnosis: 15 years.
From my diagnosis to appropriate treatment (ERP): 5 years.
From treatment to freedom: 12 weeks. (<–Read that again please.)

Exposure and response prevention (ERP) therapy is powerful, friends.

On average, it takes OCD sufferers 14-17 years to get the correct diagnosis and treatment. This is not okay.

So many OCD sufferers cannot afford treatment. In some countries, ERP therapy is simply not available. In fact, in some countries, the stigma associated with having a brain disorder like OCD is so strong that sufferers would not dare admit to needing help. This is not okay.

The creators of the nOCD app felt the same way. One contacted me and said, “Our goal is to reduce the time it takes for people with OCD to get effective treatment (from decades to minutes).” He said, “One thing advocacy has shown me is the need for OCD treatment in other countries! There are people in Bangladesh, India, etc that have literally nobody! My team is actually building a 24/7 support community within nOCD to combat this issue.”

The app is FREE and, I-hope-I-hope-I-hope, going to change the world.

Some of the very best things about this app:

Right now it’s available for iPhones, but this fall, the Android version will come out. Please check it out here. And be sure to tell me what you think!

With her permission, I am sharing a comment from ashley1234567890, one I found particularly insightful.

And here she is …

I went through ERP and had fantastic results. It was a huge blessing for me, and I thank God that he gave me the courage to try it.

I am no expert, but i did have a really bad case of OCD, which got a lot better after ERP, so here are my recomendations, that in hindsight, were key to my success.

NOTE: my ocd did not get worse with ERP (it got so much better) even though the treatment was very intense!

If you qualify for ERP therapy, and you are considering it, then do not let fear keep you from going. The only caveat is to make sure you find an expert who treats ERP because it is specialized therapy. For example, my therapist was willing to meet me outside of their office for exposures, because my ocd spiked at a particular place. I also recommend finding someone who has experience with whatever ocd you are facing. For example, my therapist had experience with germ ocd, harm ocd, religious ocd, sexual oreintation ocd, etc… so i knew they were highly qualified. they should also give you exercises so you can do your own exposures.

As for ERP, It seems counterintuitive at first, since the patient will go through exercises and narrations that are asking them to run towards their fears (instead of running away from them), which in turn causes anxiety to spike, and while super anxious the patient will be asked to temporaily stay in that state while resisting compulsions that are normally used to reduce the anxiety. If you face the obsession and not give in to the compulsion, then the cycle breaks, which in turn makes you less anxious. That is where “exposure and response prevention” comes from.

My treatment was gradual at first (small fears first then you move onto bigger ones) also, my initial exposures were designed so that anxiety was moderate so I could handle it, and then over additional sessions, they were changed to more intense ones.

For me, it took me about 12 sessions to complete treatment. I noticed some big gains after the first couple of sessions so i knew it was helping. After treatment i am a new person. I still have the ocd, triggers, and the spikes, but it does not cause much distress anymore. Before ERP my distress level was a 10 and it was constant. My life sucked.

So heres an example of what what ERP might look like. let’s say you have germ OCD. You may be asked to touch a door knob and not wash your hands afterwards for 5 minutes. As the sessions go on, and you grow stronger, you may be asked to do the same excercise, then refrain from washing for 15 minutes. Eventually, beloeve it or not, you will be able to do the excercise then not wash at all! Or, one exposure may be a narrative, where you write a short story, and in this story you get a little dirty, or exposed to germs, etc… over the treatments, the story may get more and more disgusting and intense, so you will be in a situation that gets really dirty, and theres no place to wash up etc…

As the sessions and exposures go on, the anxiety for each trigger gets weaker, which in turn makes the spikes less intense. Consequently for me, the ocd got better over time.

Again, the key is to find a qualified expert who has a lot of experience in OCD and ERP, because you will be asked to do things that will make you feel temporarily uncomfortable and the therapist will need to work with you at the right pace so that you are not overwhelmed. They should be willing to leave their office to do an exposure where you need it. So for example, if you are afraid of heights they should be up for going with you to a balcony etc… to face that fear.

Like some of the previous comments, I was anxious before starting too, and I was scared that it would make my condition worse. But i was wrong! that’s just the ocd trying to keep you in the bad place.

In fact thats how i first came across this blog. Jackie had wrote some content on ERP and it gave me the confidence to try it. Thank you jackie you are such a blessing from the Lord! Hopefully this post will do the same for someone else!

For me, being a perfectionist means that writing a book can be a slow form of torture. You see, it takes a long time for a book to even begin to resemble perfection. You have to spend months, even years, sitting uncomfortably in the middle of a mess, working through sloppy drafts and chasing rabbit trails into very disorganized forests.

Or maybe that’s just me.

In any case, it’s a continual lesson in learning to enjoy the process and not just the product. If I only enjoy the product, I will get to be happy about 24 hours out of every three years. This is a journey of embracing uncertainty, letting myself wait in the cold water till I begin to adjust.

And that’s the story of my life with OCD too. Heck, the story of my life, period.

I– a perfectionist, an OCD survivor– want pretty things in pretty boxes with pretty bows on top. I– an artist, an OCD survivor– know that’s not what life looks like. Life is full of doubt and wrong directions, wasted time and imperfect choices. Life is full of discomfort and years and years and years of tolerating discomfort … with the hope there is a pretty thing in a pretty box with a pretty bow at the end. But it is not guaranteed.

So, is art in general– or writing specifically– a difficult career choice for a perfectionist? Heck yes. But it’s fulfilling, worthwhile, hard, dirty, beautiful work– and it is helping me appreciate this fulfilling, worthwhile, hard, dirty, beautiful world.

A blog reader emailed me and asked, “If you are okay with sharing this, could you tell me why you chose to stay on your medication after ERP?”

My response:

For me, meds are a chemical tool to slow my serotonin reabsorption. ERP is a physical tool in that it rewires the brain and a mental tool in that it gives me a new mindset toward uncertainty. I’m grateful for ALL my tools. 🙂

Also in my toolbox: prayer, deep friendships in which I can be vulnerable, essential oils when needed, Ativan when needed, talk therapy for non-OCD anxiety, and self-care (i.e. naps and ice cream).

What I’m trying to say is that God has given me an extensive amount of assistance. Some tools only come with privilege or money (having insurance and a paycheck to pay for meds and therapy … and ice cream, ha!); some from transparency (I have the greatest friends); all are sheer grace.

I’m at a stage of my life and faith where my hands are open to all the grace I can get.

My friend Janet over at the ocdtalk blog recently wrote a book detailing her family’s experience with her son’s OCD and the treatment of it. I was lucky enough to get a copy of it, and I’m happy to share a review of it here with you.

I was really fascinated to finally hear Dan’s entire story when I’d gotten bits and pieces of it over the years via Janet’s blog posts. I don’t know why I’d expected it to be similar to mine– except that I relate to much of what Janet writes on her blog– but his experience was vastly different from my own! I think that a huge part of that was because Dan was being treated at a younger age than I was. The first scene of this book takes place when Dan is just 19 years old and a freshman in college, whereas I wasn’t even diagnosed with OCD until over a year after I’d finished undergrad. Though my parents are incredibly supportive and tremendous cheerleaders, taking the lead in finding help was absolutely my job. For the Singers, Dan’s parents Janet and Gary were very, very involved in every step of the process.

What I loved about this book:

It realistically portrays the hell of OCD. Nothing is watered down in this book. Families are going to be able to recognize immediately that this family truly understands the torture of OCD.

It shows that the journey to recovery can be long and complicated. I am so happy for the families that discover the right treatment immediately, but for many of us, that’s simply not the case. In my own story, it took me fifteen years just to get diagnosed, then another five years of talk therapy (inappropriate for OCD treatment) and trial-and-error prescriptions before I finally started ERP, the correct treatment.

Janet’s heartbreaking narrative is balanced with Dr. Seth Gillihan’s forthright explanations. I like that readers are given both one family’s personal experience, but that the book still dials back and addresses things more clinically and more generally. While Dan’s medications made him less himself, mine make me more myself, so I thought that Dr. Gillihan’s interjections helped keep the book balanced.

The doubt is palpable– and relatable. As Janet and Gary and Dan struggled to make the best decisions for Dan and their family, they often doubted those choices– and that’s exactly what real life is like. Many times, in my own journey, I questioned whether I should continue with a certain medication, or with meeting a particular psychiatrist, or even with therapy. It’s a scary enterprise, and this book shows that so well.

The emphasis is on hope and on the means by which it comes: exposure and response prevention therapy. People familiar with Janet Singer would expect nothing less.

I hope you’ll read this important book. It’s available at the following links:

Many, many OCD sufferers have been contacting me lately: they want to share their story, seek advice, and– in many cases– seek reassurance. Do you really think this is OCD?

My answer is pretty standard for those I believe are truly dealing with OCD. I tell them I’m not a mental health professional but that, in my experience, what they are describing sounds a lot like other cases of OCD. I encourage them to seek out ERP therapy.

They write back: So you really do think this is OCD?

But I know this routine.

It’s usually a compulsion, their asking repeatedly.

I explain this to them, remind them that I’ve already told them what I think.

I just want to make sure, they say. You really, really think this is OCD?

I explain again that their asking me over and over is not healthy for them and that they need to do ERP.

A week later, they’ll message me and ask again. I become a broken record, refusing to give in to their compulsions and doling out tougher and tougher love:

* I’ve told you what I believe and what is the solution. I have nothing more to add.
* Can you see that you’ve asked me X times now? That is a compulsion– seeking reassurance– and I’m not going to give in to it. It’ s unhealthy for you.

Or, in some cases, I won’t respond. What more is there to say?

This troubles me.

On the one hand, I know what it’s like to be gripped with the incredible fear and doubt of OCD. I know how it dials up to a fever pitch, and how desperately you just want. some. relief.

But I also know that compulsions are a short-term non-solution that only exacerbates things. I know that ERP therapy is the long-term solution.

It puts me in a really rough spot. I fear that I come across as cold, hard-hearted, tough, even rude. The years since I underwent ERP therapy have brought such intense clarity to my thinking that sometimes it’s hard for me to empathize in the same way I once could. Don’t get me wrong. I remember the 20 years of OCD hell. I haven’t forgotten. But the almost seven years since my own successful treatment have made me more confident in just about every way– including in what the appropriate treatment for OCD is. I won’t budge on it. I won’t recommend a band-aid. I can’t.

And I can’t cater to compulsions. I did that for myself for too many heartbreaking years, and I won’t give in to something that perpetuates prison for other sufferers.

In my desperate desire for their freedom, I think I come across too tough.

I don’t know the answer to this. I’m frustrated: with myself, with others.

But I know that compulsions kept me locked up and ERP set me free. That’s the line I draw in the sand. Maybe I’m being too tough on hurting souls. But I would be a liar if I gave out band-aids to cancer patients. That’s why I refuse to parry to compulsions.

For those of you involved in advocacy, is this a problem that you’ve had to face? How have you managed it with grace and compassion? I want to fight the good fight, but I feel so frustrated and tired.

This week, I counted up all the emails that the OCD community and I have batted around for the last two years, and it was near 2500. I’ve decided that– for the time being– I can no longer respond to these emails. It’s pushing me into an unhealthy place. I closed the messaging option on my Facebook page and posted this message on my Contact page:

Due to an overwhelming number of emails about OCD, HOCD, ERP, and the like, I am no longer able to respond to personal messages about these matters; I’m not a therapist, and though it honors me that you’d share your story with me, I’ve found that I am not in a place where I can handle such stories in a healthy way. I invite you to read my message to you atwww.jackieleasommers.com/OCD-help. It is everything that I would say to you in an email. I wish you all the best as you pursue freedom from OCD. Godspeed.

These actions have given me a sense of both freedom and failure, but I hope people will understand.

From time to time, life becomes so overwhelming that I have to temporarily remove my email address from my website. It’s that case right now. Between busting my butt on my next novel (especially after I changed story ideas late in the game!), trying to be healthier, working full-time as a recruiter, and trying to be a good friend, daughter, and sister, my life is pretty crazy right now.

I recognize that I’m not the only resource available for OCD sufferers, but even so, I count it as an honor that people would be willing to share their stories with me. It always hurts me to take my email address down. In its stead, I’ve added a new page on my website: OCD Help. It’s exactly what I would tell someone who approached me for advice, and I hope it will be helpful for you– or for someone else that you’d like to pass it along to.

Also, please note that I have a compendium of OCD posts here, with topics that range from ERP, HOCD, OCD & Christianity to medication, OCD & children, and remission. I hope you’ll check it out.